Skewed doctor-patient ratio and quackery major issues in public healthcare today

Skewed doctor-patient ratio and quackery major issues in public healthcare today Rural areas have only 1.1 lakh doctors and many unqualified professionals masquerade as doctors New Delhi, 29 August 2017: As per recent statistics, India has only about 1 million allopathic doctors to treat its population of over 1.3 billion people. Of this, only 1.1 lakh doctors work in the public health sector and therefore, about 900 million people in the rural areas are dependent on this small number of doctors for their healthcare requirements. According to the IMA, in such a situation, patients must share beds and doctors face severe burnout due to the skewed doctor-patient ratio in these areas. India lacks adequate number of hospitals, doctors, nurses, and public health workers. There is a wide gap in the quality of and access to healthcare. This is not just between states but also urban and rural areas. The issue is further compounded by quackery with unqualified people masquerading as doctors. In the absence of doctors, people have no choice but to visit such quacks for treatment. Speaking about this, Padma Shri Awardee Dr K K Aggarwal, National President Indian Medical Association (IMA) and President Heart Care Foundation of India (HCFI) and Dr RN Tandon – Honorary Secretary General IMA in a joint statement, said, “The recent infant deaths in UP bring to light, two very pertinent issues in healthcare delivery today: one is the skewed doctor-patient ratio and the other is that of quackery in the profession. It is a sad fact that in rural areas, the sick are first taken to the ‘so-called’ faith healers offering treatment in the garb of doctors, before they are brought in to a hospital for actual treatment. These quacks are at times educated only up to Class 12 and lack any medical qualification whatsoever. What is disturbing further is that there are not enough trained doctors in the country. Many do not wish to opt for entering the public healthcare system and this results in even ward boys proclaiming themselves as doctors in rural areas.” As per surveys, only 1 out of 5 doctors in the rural areas are qualified to practice medicine. The IMA has taken a strong stand against quackery. This was also one of the issues raised by the association in a movement called Dilli Chalo conducted in June this year. Adding further, Dr Aggarwal, said, “There is a need to conduct an updated assessment of quackery at both the state and district levels. Instead of training Ayush practitioners and quacks in prescribing allopathic medicine, there is a need to strengthen the traditional systems of medicine in offering first line of treatment and care.” IMA urges one and all to beware of quacks as they indulge in cuts and commissions, will never refer the patient in time, invariably give steroids in every case, and will over investigate the patient to appear genuine. On the other hand, people should have faith in registered and qualified doctors as they do not indulge in unethical practices, do not take or give commissions, work with the primary aim and dharma of healing and not financial gain, believe in Karma and not Kriya, and will always guide patients with the best of interest.

Healthcare shame: India ranked 154th out of 195 countries ranked by Lancet Medical Journal: DNA

Healthcare shame: India ranked 154th out of 195 countries ranked by Lancet Medical Journal: DNA This is not true: Indian Medical Association Dr KK Aggarwal National President IMA DNA has reported a Lancet study that India's poor ranking is primarily because of the rise in cases of tuberculosis (TB), diabetes, rheumatic heart disease and chronic kidney disease. India has failed to achieve in healthcare goals, badly lagging behind China, Sri Lanka and Bangladesh in terms of accessibility and quality. India was ranked 154th position in the ranking of healthcare quality amongst 195 countries, whereas some countries like South Korea, Peru and China have seen greatest improvements in healthcare access and quality since 1990. China, with a score of 74 on the index, has been ranked at 82 - far ahead of India, and Sri Lanka has scored 73 on the index. Similarly, Brazil and Bangladesh have score 65 and 52, respectively. India performed worse than expected in TB, diabetes, rheumatic heart disease and chronic kidney disease. The 32 diseases for which death rates were tracked included TB and other respiratory infections, illnesses that can be prevented with vaccines - such as diphtheria, whooping cough, tetanus and measles - several forms of treatable cancer and heart disease, and maternal or neonatal disorders. I do not agree. This is not the correct picture. Government statistics are based on data from government set ups, which cater to only 20% of the society. The remaining 80% are seen by the private sector. When we say 10 million cases of TB are missing from government data, this does not automatically mean they do not get treatment. In fact they might be getting better treatment than the government sector. Private sector results for all these 32 diseases may be better than in the government sector. We should not extrapolate any inference from such studies. Unfortunately, British media is always negative with regard to the Indian health scenario. Why, we do not know? Most of their stories against India are negative. Is medical tourism in India responsible for it?

IMA lauds nurses on International Nurses Day

IMA lauds nurses on International Nurses Day Says nurses are the backbone of healthcare and it is important for physicians to take their responsibility New Delhi, 11 May, 2017: Nurses are the backbone of any healthcare setting. They are the underdogs who play a key role in all medical institutions, and are responsible for the welfare and recovery of patients. Recognizing this, the International Nurses Day is celebrated every year all around the world on the 12th of May to commemorate the birth anniversary of Florence Nightingale and mark the contribution of nurses towards people’s health. The theme for 2017 is Nursing: A voice to lead – Achieving the Sustainable Development Goals. The MCI code of ethics states that 'physicians should recognize and promote the practice of different paramedical practices such as nursing and seek their cooperation wherever required'. Also, the responsibility for the welfare of nurses rests with the physician. India is facing a phenomenal shortage of 2.4 million nurses and the number is expected to increase, given the high rate of migration of nursing professionals owing to factors like job insecurity, working environment and gender biases. Speaking about this, Padma Shri Awardee Dr K K Aggarwal, National President Indian Medical Association (IMA) and President Heart Care Foundation of India (HCFI) and Dr RN Tandon – Honorary Secretary General IMA in a joint statement, said, "There is an enormous amount of knowledge and skill sets that nurses possess. They spend years perfecting these skills while at the same time working in decidedly tough situations which can sometimes be very stressful. They also help bring new life into the world, care for the sick and the elderly, and suffer watching people pass away despite their best efforts. At times, they bring to notice any oversight in a doctor's prescription thus averting any possible mishap. On this day and every day, we should recognize their contribution to healthcare and the hard work, long hours, and duress that are a part of this profession." It was in January 1974 that 12th May was officially declared as the International Nurses Day. There are many events and campaigns that take place all over the world to commemorate this day. As part of these campaigns, there is a need to create awareness that both men and women can be successful nurses and both have the equal right to work and earn a livelihood through this profession. Adding further, Dr Aggarwal, said," Apart from understanding that nursing is a demanding profession, there is also a need to eliminate gender biases, promote better and uniform pay for nurses to reduce the incidence of migration to other countries, and strengthen the education and training system for nurses in India. This can be done by setting up more colleges and training centres and encouraging practical training." Nurses are the most resilient entities in a healthcare setting as they see a patient through all highs and lows. Any small initiative on this day to appreciate their place and presence in healthcare and thank them for all their efforts will go a long way in recognizing their importance in society at large.

Straight from the heart - Enough is Enough: ‘Chalo Dilli’ on 6th June

Straight from the heart Enough is Enough: ‘Chalo Dilli’ on 6th June Dr KK Aggarwal National President IMA Dear Colleague The Indian Medical Association (IMA) has declared “Chalo Dilli” movement on 6th of June to bring to the attention of the nation that the medical profession is being strangulated from all directions. Justice has been denied to doctors even within the frame work of the constitution of India. • Why is everybody silently watching violence against doctors? We become doctors to serve and not to harm the community. We are not against accountability but no one can be allowed to take law in their hands. Violence against healthcare professionals is occurring with growing frequency in India and there is often an attempt to soften the outcry by blaming the medical professionals being the cause of provocation. While every hospital and healthcare facility should identify high-risk violence prone areas in their establishment to be manned by adequate number of doctors, CCTV cameras and adequate security, all healthcare providers, who are victims of violence, must be adequately compensated. A well-structured and effective Grievances Redressal mechanism at each clinical establishment should be established (both for patients or their relatives and for the healthcare providers), timely and transparent root cause analysis of every case of violence should be done and entered in a centralized IMA registry. It’s our luck that Hon’ble acting Chief Justice of Delhi Smt Geeta Mittal and Hon’ble Justice Anu Malhotra in a suo moto order dated 3.05.2017 have made IMA as a party in the case. Directly or through the court, we want the Ministry of Health and Family Welfare, Government of India to urgently and promptly implement MCI suggested amendments of making soft skill communications compulsory for UG and PG curriculum. Also based on the inter-ministerial committee recommendations, the Central Government should enact a central act against violence at the earliest on the lines of one enacted in 19 states and make the violence against doctors as non bailable offense punishable with up to 14 years imprisonment on the lines of abatement of a murder because violence against doctor can end up with death of other unattended patients. • How come we are suddenly being tried as criminals? Of late, medical professionals are being tried under criminal law for medical negligence. In order to establish criminal liability, it is important to ascertain whether intent to harm (mens rea) was present or not. But in criminal negligence cases, intent to harm has been replaced by gross negligence. Gross negligence itself is not defined in IPC. Moreover, criminal law punishes only affirmative harm but in medical negligence failure to act in a prudent manner also is a crime. It should not be forgotten that medicine, especially emergency medicine, is inherently risky. Adverse outcomes or mistakes do not necessarily mean that care was negligent or that health care providers are criminally at fault. The sections of IPC 304 A (death due to negligence), 336 (act endangering life or personal safety of others), 337 (causing hurt by act of endangering life), 338 (causing grievous hurt by act of endangering life) are being frequently applied against medical practitioners. Moreover, sections of MTP Act, PCPNDT Act, POCSO Act, HIV-AIDS Act, West Bengal Clinical Establishment Regulatory Commission Act etc. are also being applied against medical practitioners for technical reasons and medical professionals are prosecuted. To treat a patient, the medical professionals often have to take calculated risks and take decisions. If they fail to do so it may further complicate the situation. So it becomes difficult to define gross negligence. Besides, one has to consider Section 88 of IPC, which saves medical professionals from criminal liability when the act is done in good faith. Hence, Section 304 A and similar sections of IPC should only be considered along with Section 88. Yet with every passing day, doctors are being prosecuted under 304 A when there is no mens rhea between the doctor and the patient. Under the new acts including the PCPNDT Act, even clerical errors are being linked to penal provisions. In West Bengal Clinical Establishment Regulatory Commission Act, the word used is ‘shall’ for imprisonment of up to three years for any violation of the act. We want de-criminalization of clinical practice. • Why are the limitations of the government being faced by the doctors? It is the constitutional duty of the governmental to provide free drugs and investigations for primary care and emergent care. The very fact that 80% of health care services are handled by private sector means either the services of the government are not up to the mark or they do not have enough infrastructure. The private sector is doing the job of the government. Then why so many exams for the medical students, so many registrations for opening a new medical establishment and so many windows for accountability? Why can’t we have single window registration and single window accountability? • When it is the government who has allowed the same company to manufacture generic-generic, trade generic and branded generic medicines at differential prices, then why punish and defame the doctors? Why take away the prescription rights of doctors and give it to un-qualified chemists. Why is the government allowing pharmacies to be run by outsourced non-professional chemists? It’s not the doctor’s job to search for the cheapest brands. It’s like government saying that we will allow drugs to be sold at variable prices but you should not write the costlier ones. In other words, we will give licenses to five-star restaurants but no one is allowed to go there. The right to choose the brand or the company name is with the doctor who owns the legal responsibility of the case. If the brand is chosen by the chemist, who will be responsible if the patient dies during treatment. • Why do we need a government? Why not a Supreme Court Monitoring Committee or twenty nominated members to run the government? If not then why attempts for an autocratic, bureaucratic, undemocratic, non-representative, 20-member nominated body including 8 non-medical persons to oversee medical education, ethics and practice by abolishing a democratically elected federally represented 168 members Medical Council of India (MCI). If you feel the IMA Act needs amendments, go for that. • The country is already short of doctors then why an MBBS graduate who has gone through 36 examinations in 3 dimensions to get his degree is being asked to sit for another 3 hour MCQ paper to obtain his license under NEXT. • By promoting AYUSH to practice modern medicine are we not finishing the very existence of AYUSH in the country? Scheduled drugs should only be allowed to be written by MBBS or BDS doctors. • The floodgates of modern medicine practice are being thrown open to quacks and no action is taken. No unqualified person should be allowed to prefix doctor in front of their name. • When medical profession is considered noble and doctors provide subsidy in the consultation to all patients then why compensation is awarded in crores basing it on the patient’s income? And why another act to compensate in West Bengal Clinical Establishment Regulatory commission? • Why are professional decisions taken without taking the medical profession into confidence? Why can’t IMA be in every policy making committee of the government. There is no end to the injustice heaped on the medical profession. Every doctor in India should participate in the “pen down strike” on 06.06.2017 while “IMA Satyagraha is walk in protest”. All Medical Colleges in the country SHOULD remain shut as well on 06.06.2017. Let us not compromise on our demands • Central Act against violence • Stop NMC and Amend IMA Act • No to NEXT • Decriminalization of medical practice and clerical errors • Modern medicines to be prescribed only by MBBS or BDS doctors. • Professional autonomy in prescriptions. • Immediate implementation of the inter-ministerial committee recommendations. • Amendments in Clinical Establishment (Registration and Regulation) Act 2010 and West Bengal Clinical Establishment (Registration, Regulation and Transparency) Act 2017. • No unqualified person should be allowed to prefix ‘Doctor” before their name. • No chemist should be allowed to sell or run a pharmacy without a degree in pharmacy.

Budget Reactions - Healthcare

Budget Reactions - Healthcare Two new AIIMS, 5,000 new PG medical seats per annum, action plans for elimination of diseases like Kala Azar, Filariasis and Tuberculosis (TB), Safe Water for areas affected by fluoride and arsenic, transformation of 1.5 lakh health subcenters into Health and Wellness centers, separate health cards for elderly, Rs.6,000/- aid for every pregnant women, accreditation of colleges and promoting health care indirectly by increasing budget for road safety, agricultural, rural health and Swachh Bharat, the current budget is a step forward for improving the health care of society. But still more could have been done. While the proposal to set up two new AIIMS in Gujarat and Jharkhand is a positive development, IMA wants an AIIMS in every state and an overall increase in the budget allocation to 2% of GDP to cover 80% of population who do not avail government health services. This year's budget makes a commitment towards structural regulatory reforms in medical practice and education as well as digital health. Though more focus could have been given to R&D in healthcare, many of the provisions are worth a mention and a step in the right direction. In a move to widen the availability of essential drugs across India, an Amendment to the Drugs and Cosmetics Rules has been proposed. This will ensure availability of medicines at reasonable prices and also help people get access to life-saving medicines. New norms will also be formulated for the medical devices sector in order to reduce the cost of such devices and encourage investments. The government also plans to add 5,000 post graduate seats per annum. More qualified doctors being the need of the hour for both urban and rural areas alike; this is a step in the right direction. The government has also taken a positive step by deciding to start DNB (Diplomate National Board) courses in many District hospitals across the country, strengthen PG teaching in select ESI and Municipal Corporation Hospitals and encourage reputed Private Hospitals to start DNB courses. But the country needs more family doctors. All the PG seats that remain vacant may be converted into PG Family Medicine seats. Action plans to eliminate Kala Azar and Filariasis by 2017, leprosy by 2018, measles by 2020 and TB by 2025 will bring a major relief. Focusing on elderly health care, the proposed Aadhaar card-based smart health cards would be a move in the right direction. The Government also plans to bring down the maternal mortality rate (MMR) to 100 by 2018-2020 and also reduce the infant mortality rate (IMR) to 28 by 2019. The budget also has provisions for personal income tax as follows: · Existing rate of tax for individuals between Rs 2.5- Rs 5 lakh reduced to 5% from 10%. o As a result of the combined effect of the new Section 87A rebate and the reduction in the lowest slab tax rate to 5% the tax burden for those with income up to Rs 3 lakh would be zero and tax burden those in the Rs 3 lakh to Rs 3.5 lakh bracket would be Rs 2500. o Those earning Rs 4.5 lakh can therefore reduce their tax liability to zero by fully utilizing the tax break under Section 80C combined with these new proposals. o Those falling in the higher income tax slabs will also be eligible for this lower tax rate of 5% on income between Rs 2.5 lakh and Rs 5 lakh. Therefore, those in the higher tax slabs will pay lower tax by Rs 12500 per person. o Individuals earning between Rs 50 lakh and Rs 1 crore will have to pay a surcharge of 10% on the total income tax payable by them. Currently there was no such surcharge on this category. Only those with income above Rs 1 crore were required to pay surcharge of 15% which continues · All other categories of tax payers in subsequent brackets will get benefit of Rs 12,500. · Simple one page return for people with annual income of Rs. 5 lakh other than business income. · People filing I-T returns for the first time will not come under govt. scrutiny. · 10% surcharge on individual income above Rs. 50 lakh and up to Rs 1 crore to make up for Rs 15,000 crore loss due to cut in personal I-T rate. The 15% surcharge on individual income above 1 crore remains.